About one-third of people will get shingles in their lifetime, and while the shingles vaccine is only about 50 percent effective, it is still worth it to avoid getting the virus, said Dr. Jane Weida, director of clinical affairs for the College of Community Health Sciences’ Department of Family, Internal, and Rural Medicine.
Weida gave her talk, “Immunizations for Older People — Staying Sharp on Shots,” on Feb. 9 as part of the Mini Medical School lecture series put on by CCHS in collaboration with UA’s OLLI program.
Mini Medical School lets adults and community learners explore trends in medicine and health, and the lectures by CCHS faculty and resident physicians provide information about issues and advances in medicine and research. OLLI, short for the Osher Lifelong Learning Institute, is a member-led program catering to those aged 50 years and older and offers education courses as well as field trips, socials, special events and travel. The lecture series is open to OLLI participants and to the public.
Shingles is caused by the same virus that causes chickenpox. A painful rash develops, usually on a single area on one side of the body, that can be very painful, said Weida, who is also an associate director of The University Family Medicine Residency, operated by CCHS, and an associate professor of Family Medicine.
View Fox 6’s report on Weida’s talk:
Someone who has had chickenpox can get shingles.
“When you’re little you get chickenpox and then the virus stays in the nerves along the back and neck,” said Weida. “Sometimes, we don’t know how, it reactivates.”
Being older, having poor immune function and having had chickenpox before 18 months of age increases the risk of shingles.
“If you never have had the chickenpox, you can’t get shingles first,” she said. “If you’ve never been immunized for chickenpox or shingles, you should get immunized for both. You can catch chickenpox from someone with shingles, but not shingles.”
Insurance will cover the shingles vaccine after age 60, though it can be given starting at age 50.
Older people need immunizations to boost immunity to diseases, even those to which they have already been immunized, such as tetanus, diphtheria and whooping cough, and to protect against diseases that affect older adults preferentially, including shingles and pneumonia, said Weida.
Weida also encouraged attendees to get their flu shot each year, as 3 million to 5 million people are infected by influenza each year, and 250,000 to 500,000 die each year from the flu. The best time to get your flu shot is about mid-October to November, said Weida.
The flu shot’s effectiveness can fade, Weida said, so it is important not to get it too early, especially for those older than 65.
The flu is spread through coughing or sneezing and by touching surfaces with the virus. However, soap and water deactivates the virus, Weida said.
Schizophrenia
On Feb. 2, Dr. Thaddeus Ulzen, associate dean of Academic Affairs and chair of Psychiatry and Behavioral Medicine, gave his talk on schizophrenia, which is a chronic and severe mental disorder that affects 1 percent of people worldwide.
Symptoms typically present between late adolescence and early adulthood. Ulzen said that symptoms may be subtle, but those around the person may notice that “something is just not quite right, or the person is not his or herself.”
Symptoms include hallucinations, delusions, thought disorders and movement disorders. Reduced emotions and feelings of pleasure and reduced speaking may also be symptoms.
“I describe it as a disruption of what I call ‘security of thought’—that your thoughts belong to you,” said Ulzen. “The feeling is that someone is intruding on your thoughts.”
Medication can be used to treat schizophrenia, but other aspects must be introduced into the treatment, said Ulzen, including psychosocial interventions and cognitive behavioral therapy. Community treatment, which includes family education and support, is also important.
Schizophrenia cannot be cured, and those affected with the disorder have it for life.
“As a child psychiatrist, I always say that we are in preventive psychiatry. Most disorders we see, including schizophrenia, start quite young.”
Ulzen said he works with general physicians to help them identify the signs of schizophrenia and other psychiatric disorders.
“My job is to help physicians understand that this is the beginning of the big tsunami about to come and never to say ‘It’s just a phase.’ If the patient is concerned enough to walk into the room, they know something is wrong.”
Addiction and Teens
In a 2015 study, one out of 17 high school seniors were daily smokers of tobacco, said Dr. Sara Phillips, assistant professor of Pediatrics at CCHS, during her talk “Addiction and Teens” on Feb. 16.
According to the CDC, cigarette smoking causes about one of every five deaths in the US each year and life expectancy for smokers is at least 10 years shorter than for nonsmokers. Quitting smoking before the age of 40 reduces the risk of dying from smoking-related disease by about 90 percent, said Phillips.
“I think if we target young people and try to get them to quit early on, it could be like they never smoked.”
Most teens want to quit, she said, and nicotine replacement and cognitive behavioral intervention can be helpful forms of treatment.
While there are other dangerous drugs that teenagers use, smoking causes annually more deaths than overdoses have in 15 years, said Phillips.
More money is spent on tobacco advertising than any other drug, though there are regulations.
Advertising for alcohol is not regulated, and people aged 12 to 20 years drink 11 percent of all alcohol consumed in the US. More than 100,000 deaths can be attributed to excess alcohol consumption, including the deaths of 5,000 people younger than 21 years, said Phillips.
Younger drinkers are more likely to develop alcohol dependence or abuse later in life, and they are at higher risk of suicide and death from alcohol poisoning. This is for a couple of reasons, said Phillips.
“One, their brains are not fully developed, and two, they’re novices to drinking. They don’t know their limits,” she said.
Of illegal drugs, marijuana is the most commonly used and adolescents can become addicted, despite popular belief, said Phillips.
One study showed an average loss of eight IQ points with heavy marijuana use as a teen and continued use as an adult. It can also lead to memory problems, breathing issues and hallucinations and paranoia.
Genetics can play a role in addiction in teens. Children whose parents are alcohol-dependent are four to six times more likely to develop alcohol dependence compared to others with no family history. Teens with mental health issues are also more at risk to use or abuse substances, Phillips said.
Cholesterol
Treating cholesterol isn’t about treating a number—it’s about treating the risk factors and the disease process, said Dr. Ed Geno, assistant professor of Family Medicine in the College’s Department of Family, Internal, and Rural Medicine.
Cholesterol is essential in the human body, said Geno. Two types of cholesterol levels are checked: LDL and HDL. The two have different clinical implications:
LDL carries cholesterol from the liver to the tissues and deposits it. Geno called this “lousy cholesterol,” which is how he helps patients remember it is not good for that number to be too high.
“Happy cholesterol” is how Geno helps patients remember HDL, which carries cholesterol from the tissues back to the liver.
High levels of the LDL cholesterol can lead to plaque buildup in arteries and lead to cardiovascular disease (CVD).
Statins may be used to prevent CVD in adults.
“We are trying to use primary prevention in treating cholesterol,” Geno said. “That means we are trying to keep someone from ever having a heart attack. Secondary prevention would be keeping a heart attack from happening again.”
When treating a person’s cholesterol, risk factors and the disease process is taken into account—not just the patient’s cholesterol numbers.
Adults without a history of CVD may be prescribed a statin for the prevention of a CVD event and mortality depending on if: 1) the adult is between age 40 and 75; 2) the adult has one or more CVD risk factors, which include dyslipidemia, diabetes, hypertension or smoking; and 3) the there is a calculated risk by the physician of a cardiovascular event within 10 years.
